Male Circumcision and HIV

NHPC 2009: Publicity and Stats [Updated with additional link]

One could almost hear the American public rushing to their computers to google "circumcision and HIV" at the start of the National HIV Prevention Conference held in Atlanta over the last few days. Ok, I'm joking a bit. But we did do well in those three days. Our stats went through the roof. We weren't posting any particularly insightful commentary, such as here, and here, and here, and here, and here, and here, and finally here. These are just some of the great commentary that I can remember. If there are others, please let me know.

UPDATE: And an additional very insightful commentary here.

Anyhow, on MC_HIV, we hit the highlights. Thanks to all the new visitors. I hope you will stick around.

Two Years of Male Circumcision and HIV

Two years ago today, I registered circumcisionandhiv.com, .net, and .org in disgust over the newest cause celebre of the Aids industry, claims that circumcision prevents HIV infection. Within 48 hours, this site was born. We, among the intactivist community, knew this day was coming because the usual suspects had made claims for years before funding was obtained to conduct random controlled trials. I think we were ill-prepared to meet the newly RCT backed claims head-on. Nonetheless, we have slowly responded as well as a purely grassroots movement can.

I was of two minds when I got this thing going. On the one hand, I toyed with the idea of fronting a purely science-based critique. Slowly, I began to realize that such an approach was virtually impossible to mount. It is one thing to argue that adults are ill-advised to rely on removal of skin from their penises for protection from HIV. It is quite another to confront the hidden agenda of shoring up neonatal circumcision in the United States, let alone exporting the practice to every health care weak point on the globe.

Circumcision is the most psychologically complex surgical practice ever introduced. Only female circumcision approaches the psychological confusion it engenders in its victims. And so, my other considered approach was a full on attack on the practice, regardless of its practitioners justifications, along all lines, whether policy, practical, scientific, or psychological.

We have settled into a middle ground somewhere between the two.

While we deny that circumcision, even in its now state of received knowledge, has any place in HIV prevention, where better proven, more effective means are already available, we accept that adults are masters of their own bodies and can choose to submit to the surgery with full knowledge of the detriments. Meanwhile, we assert that a child's human right to physical inviolability, the human right of all individuals regardless of age to be free from medical treatment without consent unless necessary for his or her immediate health and welfare, and the inherent right of all people to physical autonomy, must not be abrogated under lesser circumstances.

The fight against the male variant of circumcision looks to be a struggle that will continue beyond the lifetimes of most of us. As such, we need to be mindful that we have to measure our success in a variety of ways. Each child saved is a success. Each person who understands our position is a success. Every time we come out with our belief in these principles among people who may not share them, we have achieved something. The very fact that a Google search or a Yahoo! search returns our views from a variety of different sites and sources is a victory.

My heartfelt thanks to all who come here to read what we write, and then some to those who comment.

Subscriptions are here ...

Dear Reader,

Starting today you can support our work with a monthly subscription. Money donated will remain in our account for special projects and original reporting. Day to day expenses for hosting and software will continue to be paid by me. Help us reach a milestone of $15,000.00 per year in donations, so that we can begin a long held goal to do original reporting.

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Thank you,

David

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Patience, my friends

From time to time, things get hectic. And this is one of those times. The World interferes with the best of intentions. We have a number of posts lined up, awaiting editing and deliverance. Plus, we're working on a page dedicated to the Genital Integrity 2008 conference at Keele. It'll get done. Only slowly. Thanks for your continued visits ... and patience with the bloggers here at Male Circumcision and HIV.

Meanwhile, peruse this ICGI press release on the effectiveness of condoms over circumcision. We did a post on a previous press release viz this study here. But ICGI gives a good summary.

And of course, scroll down for Joe's latest on teen sexual health in America.

Extending our reach, making it pay (not easy)

I'm not here to complain by any means about the commitment it takes to keep up with the topic of this blog. However, fans and enemies alike may be interested to know the commitment it takes. As such, I was rather pleased to see this breakdown of the data on bloggers and blogging published by Technorati and blogged by TechCrunch.

Choice quote:

Blogging is a volume game. The more you post, the more chances there are that someone else will link to one of your posts. (Technorati rank is based on the number of recent links to your blog). The majority of the Top 100 blogs tracked by Technorati post five or more times per day, and a full 43 percent post more than 10 times per day. Meanwhile, 64 percent of the 5,000 blogs ranked lower than 600 post two to four times a day, which is still a serious commitment.

The actual TechCrunch post is chalkful of graphs and stats on the attributes of a really heavily trafficked blog. Most interesting stat? 100,000 hits a month translates into $75,000.00 a year from advertising and sponsors. Not bad for a full time job. Not great, but not bad. We get about 1,800 hits a month. Still a long way to go, a very long way ...

New media, original reporting ...

A three part series on the future of MC & HIV (Part 3 of 3)

Read Part 1 and Part 2 of the series.

Independent and Specialized Journalism

The fact that anybody can create a weblog in seconds shouldn't be confused with what a weblog can be. In its initial form, it was a way to record ideas or events or to communicate. Personal blogs are a great example of these. The internet is full of personal blogs communicating to friends and family the daily goings-on of their creators.

Soon, weblogs became a way to comment. Political blogs filled this niche. Just about anyone could be a political commentator. Some have become quite successful at it.

Lately, blogs have become a medium for reporting. Tech, fashion, and local newspaper blogs have popped up in this space. Scattered among this last category have been a few blogs that seek to do investigative reporting. The most promising combine elements of freelance reporting with NPR tactics* for support.

These blogs use video, audio, text and photos. Yet, it has become very apparent to this inexperienced producer of content that video is massively time-consuming. Audio is less so, but only just. Interviews aren't so hard if you can get people to trust you. This requires long lead times. Investigative reporting is a full-time job.

Obviously, it has quickly become apparent that one person, even doing a labor of love, can't create a dynamic journalistic enterprise and maintain a full-time job (as I must at the moment).

What is the solution?

If this blog had an independent income from advertising or some other source, or a strong donor base, could I produce more original content? Undoubtedly, yes. Would I be able to do it under the current circumstances? Not quickly. That's the irony. You either go full-bore with the expectation of some future goal of sustainability, or you remain amateur.

From my research, two ways currently exist to make MC & HIV sustainable. Either traffic picks up significantly and advertising becomes a viable source of income or the donor base strengthens considerably. That's to say, NPR tactics come into play.

MC & HIV is New Media

Tech, fashion, and political bombast receive lots of eyeballs. Serious journalism and activism less so, much less so.

The Frontline Club recently sponsored a discussion that seemed to pit the mainstream media against bloggers concerning financial viability. It's a fascinating discussion because it shows that Big Media spends a lot of money on infrastructure for, so far, no return while bloggers of various stripes use TypePad and WordPress for very little money and hence a pretty significant return on investment.

I'm not saying either side has direct applicability to what we're trying to do here. But the lessons are instructive looking forward. The discussion below gives the reader an idea of the discussion going on now between Big Media and bloggers viz financial viability and relative political and social influence. The medium can be powerful once we get going with it. And once we get it going, it can be sustainable.

Join us, please.

*NPR tactics refer to the quarterly interruption of programming on National Public Radio in the United States to beg for money to keep operations going. It is an annoyance that has worked quite well for over four decades.

Weblogs evolve, so must we ...

A three part series on the future of MC & HIV (Part 2 of 3)

Read Part 1 of the series.

The Vision & The Reality

This is what I envisioned for this blog:

Male Circumcision & HIV seeks to engage the public in policy questions regarding the nexus of male circumcision and HIV. It is an aggregation of media critique, interviews, original reporting, and travelogue to the regions of the world where HIV has hit hardest.

This is how the blog has developed in reality.

Male Circumcision & HIV is a layperson's weblog that posts primarily media critique and the occasional summary of recent studies on the issue of male circumcision and HIV.

In the beginning, I invited various people to step in and post items occasionally in order to ensure frequent posts with a multitude of voices on this issue. This was a tricky proposition because it takes a special type of person to write about this issue. Thoughtful, literate, and sensitive are three important characteristics. So is thick skin that won't easily chafe under the strains of difficult and disagreeable news. It is important that contributors are committed to the issues, which has narrowed the candidate pool considerably to those I have some familiarity with.

Little came of my entreaties to join me. A few people expressed interest, but nothing came of any of it. It was in these dark moments when the posting schedule had become once a week or long stretches of no posts were followed by two or three in a week, I began to wonder what is the impact of this blog anyway.

We get between 50 to 75 hits a day. About 35% are returning readers who receive the posts by RSS feed or who have presumably bookmarked us. About 55% are random and come to us through search engines. The rest, about 10%, come through Google Ads.

We also have regular visits from the Centers for Disease Control and Prevention, Harvard, Stanford, UC Berkeley, the London School of Hygiene and Tropical Medicine, the National Institutes of Health, and many other professional organizations and educational institutions. South Africa and other African countries provide a large group of visitors as does the rest of the world, particularly North America, Australia and New Zealand.

Moving the Reality Closer to the Vision

Bringing the reality closer to the vision requires two things. Money and time. True, dedication is necessary. A strong stomach for a fight doesn't hurt. A formal plan would be useful. An assistant and an intern would be welcome. But the prerequisites are money and time. In that order.

Why is money important? Because money buys time. Mine and that of others who would work on this project. Infrastructure is cheap. About 50 cents a day. But the costs of molding the raw material of information and information technology into a coherent and effective policy voice are not inconsequential.

Tomorrow, Is A Business Model for Independent  and Specialized Journalism What We Need? (Spoiler: Yes.)

Crawling out of the muck ... or rather "Our Future"

A three part series on the future of MC & HIV (Part 1 of 3)

Much like the first creatures who crawled out of the muck and realized that they possessed human consciousness, I have lately been asking myself, why are we here? What is our purpose? If I speak, does anyone hear? And lastly, but perhaps most profoundly, where are we going?

No, I'm not having a "come-to-jesus" moment. Rather I am talking about the future reach and evolution of this weblog. I have tried to define MC & HIV as a place for policy debate and discussion. I have mulled over its real and potential reach and impact. At times, I have wondered whether I was the one who should be responsible for it.

In the beginning ...

In December of 2006, the worlds of male circumcision and HIV prevention collided. While the AIDS community was throwing up its hands in despair over the raging epidemic in Africa and the somewhat eroding interest of the rest of the world where AIDS has not been a disaster, the message of a cabal of researchers with a longstanding, prior interest in circumcision reached a crescendo that was a long time coming. They pitched the idea that all we had to do was circumcise the world and the HIV/AIDS problem would be largely solved.

They based their hypothesis on the relatively lower prevalence of HIV in West Africa vs. East Africa and Muslim Asia vs. Thailand. At the same time, other researchers had been predicting wildfire epidemics in the rest of Asia and Eastern Europe and Russia for a decade or longer. All the world was at risk, we were to believe, from heterosexual transmission.

This was a ripe environment to conduct studies to see if a difference could be discerned in HIV infection rates between intact and circumcised men. Small differences were detected after 18 months. Instantly, the studies were shut down and the scientific (or should we say sciencey) papers were written. This happened despite:

1. Absolutely no statistically meaningful differences in infection rates on a demographic level within countries of similar or same ethnic practice, save circumcision;
2. Failure to consider non-sexual means of infection, particularly iatrogenic causes such as infection caused by defective medical practices;
3. Failure to investigate, let alone, factor in the possibility of non-heterosexual transmission;
4. The impossibility of following up on the majority of participants for logistical and practical reasons; and
5. A naive or dishonest interpretation of the admittedly incomplete data.

This new wave of circumcision hysteria, often employing loaded phrases such as "lack of circumcision," threatened to undo decades of work by intactivists and human rights activists concerned about genital mutilation, both that of the male and female variants. It was suspected and almost immediately confirmed by the usual suspects themselves that the real target of this research was not populations at risk, but rather the waning circumcision rates in the United States and implementation of neonatal circumcision on an industrial scale with presumably industrial scale funding in hard hit areas of East Africa.

In case the rest of the AIDS community was not listening, these same researchers with an agenda began a campaign to discredit targeted education and outreach, and even attacked condoms as lacking evidence of effectiveness.

The operative word in non-profit is profit as any good non-profit CEO will tell you quietly. Many a talented executive has made a small fortune in the non-profit sector. The Baileys, Halperins, Klausners, and Kilmarxes of the world know this well. This is not to say that good intentions and a strong motive to do good in the world isn't a prime force in its own right. This is in fact what motivates the funders of new and emerging programs.

However, circumcision is different. Its acceptance and promotion speaks to the guilt that the Western World, more specifically the English-speaking world, carries from having ignored genocide to having oppressed or murdered circumcising communities, respectively, from the Jews of Europe to the Muslims of the Middle East. It is in this broad context that a procedure with great potential for mischief, oppression, misuse and abuse has found a new constituency: the American-dominated AIDS prevention community of NGOs.

And so, the doubts and questions are left to lay persons to express, lay persons who don't have constituencies or powerful institutions to pose the necessary questions and doubts. Instead, what we have is the 'net.

Tomorrow, Vision vs Reality

The Choir and the Converts: How many of each?

I often get great email. But sometimes I wonder if we reach more than just the choir. I've used Sitemeter for a while now, and now also Google Analytics to gauge how many people lay eyes on my modest attempt to win friends and influence people (Remember ol' Norman Vincent Peale Dale Carnegie? Neither do I.). Here's the last 30 days of stats.

That's a fair number. But how many are people who check in throughout the day as I do on a number of blogs I follow? And how many people are brand new at questioning circumcision and HIV? Hard to know. Google Analytics is a little better than Sitemeter for that info, but they don't have bright and shiny reproducible graphics like the one above. After I've racked up some time on Google's traffic meter, I'll do an update.

[Written 4/1/08, published 4/2/08.]